LAUSR

Video Objective To introduce a novel uterine manipulator and demonstrate its safety and performance in laparoscopic hysterectomy and present initial data Setting It is generally accepted that a uterine manipulator is essential for laparoscopic hysterectomy as it significantly improves surgical safety and efficiency. This utero-vaginal manipulator is reusable. It has uterine manipulator and vaginal delineator that comes with different sizes (30 mm, 35 mm, 40 mm). Vaginal delineator delineates vaginal fornixes very well, maintains pneumoperitoneum, keeps perivaginal fascia intact, and displaces the ureter from cervix for safer dissection. It can be used for total laparoscopic hysterectomy (TLH), or supracervical hysterectomy (LSH), myomectomy, sacrocolpo/hysteropexy, cerclage and vaginal retrieval of fibroid, adnexal mass, lymph node etc. Interventions 24 patients underwent TLH or SLH for benign indications. TLH and SLH was performed using the Alan Utero-Vaginal Manipulator II-H. 22 patients underwent TLH and 2 patients underwent LSH. Average patient age was 48.58 (34-75). 14 (58.3%) patients had undergone previous surgery. 22 (91.6 %) patients underwent additional surgeries (e.g. salpingectomy, sacro-colpopexy). Average blood loss was 37.08 ml (20-100 ml). Average uterine weight was 98.09 g (47 g - 487 g). Average time for hysterectomy (from skin incision till completion of colpotomy or supracervical transection) was 29 minutes (22 min -48 min). There was no major complication (e.g., injury to internal organ, thromboembolism), return to theatre or conversion to open surgery. There was one post-operative minor complication (vaginal cuff infection) that was treated by oral antibiotics as outpatient. It was easy to assemble, insert and use the utero-vaginal manipulator that provided wide range of manipulations (e.g., elevation, ante-version, retro-version, and lateral movement). It was easy to identify anterior, posterior and lateral vaginal fornices. Pneumoperitoneum was maintained well during colpotomy. Conclusion Our initial experience suggests that the Alan Utero-Vaginal Manipulator II-H is safe, efficient, cost effective, and easy to use.